GERD (Acid Reflux)

GERD

The very well known "acid reflux'' is called the GERD, abbreviated as ''gastroesophageal reflux disease'' in medical terms.

A very simple explaination of this would be-

"Entry of stomach contents into the esophagus.''

This could get really irritating, as the contents in the stomach have an acidic pH(due to the gastric acid which is normally secreted for proper digestion); thus when the lining of the esophagus comes in contact to the acidic contents, it produces a burning sensation/irritation.

Now, why exactly does this happen....?

Here is a simple and detailed explaination to it.

 In a normal setting, there is a circular band of muscle layer at the junction of the esophagus and the stomach, called the lower esophageal sphincter (LES).

The LES acts like a gatekeeper in that, when closed, it prevents the acidic contents of the stomach to enter the esophagus; and when open ,allows food bolus to pass down to the stomach.

This is where the LES is lacking in GERD. 

So now our understanding becomes simple.

Acid reflux occurs when the LES does not tighten /close after food is passed to the stomach from esophagus, the sphincter weakens.

Acid has corrosive action and hence damages the esophageal lining/mucosa.

DIAGNOSIS

Your doctor will start with a physical exam. He'll also ask some questions about the problems you're having and your medical history. He'll send you to a specialist called a gastroenterologist who will perform tests to figure out what's behind your issues:

• Ambulatory acid probe test: This test measures how much acid is in your stomach over 24 hours.

• X-rays:You'll swallow a chalky liquid called barium. It will coat the inside of your throat, stomach, and upper intestines. That will make it easier for your doctor to see any problems in these organs on an X-ray.

• Endoscopy: Your doctor will put a long, thin tube and tiny camera into your digestive tract to look for damage.

• Manometry: Your doctor will thread a long, thin tube into your esophagus to measure how your esophagus moves and how it pushes acid upward. This is also called esophageal motility testing.

RISK FACTORS

Conditions that can increase your risk of GERD include:

• Obesity
• Bulging of the top of the stomach up into the diaphragm (hiatal hernia)
• Pregnancy
• Connective tissue disorders, such as scleroderma
• Delayed stomach emptying

Factors that can aggravate acid reflux include:

• Smoking
• Eating large meals or eating late at night
• Eating certain foods (triggers) such as fatty or fried foods
• Drinking certain beverages, such as alcohol or coffee
• Taking certain medications, such as aspirin.

This condition of weak LES is more common in individuals of age more than 40 (may occur is younger age group as well).

Most frequent complaints include:

Heart burn after intake of food, Dysphagia( lack of hunger), chest pain( often mistaken for heart disease) .

Microscopic examination in a pathology lab will reveal mild thickening of the esophageal wall and numerous eosinophils at the site of lesion.

TREATMENT

At first non pharmacologic therapies are implemented. These include lifestyle modifications: 

• Keeping the head of the bed elevated
• Losing weight
• Quitting smoking
• Avoiding caffeine, alcohol, and mints
• Not eating anything 2 hours before bedtime

Apart from these lifestyle changes, medical intervention is required in most of the cases. In most cases, over the counter drugs like-

• Antacids
• Proton pump inhibitors
• H2-Histamine blockers give relief.

In severe conditions, surgery is to be done.

Fundoplication

This is the standard surgical treatment for GERD. It tightens and reinforces the LES. The upper part of the stomach is wrapped around the outside of the lower esophagus to strengthen the sphincter. The preparation for this surgery is typical of that for any surgical procedure. It may include:

• a clear liquid diet 1-2 days before surgery
• not eating on the day of surgery
• taking a medication to cleanse your bowels the day before surgery

TIF (Transitional Incisionless Fundoplication)

This procedure is used when open fundoplication is not appropriate. It creates a barrier between the stomach and the esophagus. The barrier prevents reflux of stomach acid.

This procedure doesn’t require incisions. A device called an EsophyX is inserted through your mouth. It creates several folds at the base of the esophagus. The folds form a new valve. Since it does not require incisions, this can be a good option for people with GERD. However, this considered second to Fundoplication due to feasibilty.

Stretta Procedure

Using an endoscope, an electrode at the end of the tube heats your esophageal tissue and creates tiny cuts in it. The cuts form scar tissue in the esophagus. This blocks the nerves that respond to refluxed acid. This scar also strengthens surrounding muscles. This is a new method and hence long term results are unknown.

Bard EndoCinch System

This system also uses an endoscope. Stitches are made to form pleats in the LES. This strengthens the LES. 

Because the beads are magnetized, they move together to keep the opening between the stomach and esophagus closed. Food can still pass through normally. This is a relatively new procedure but shows good results for relieving acid reflux disease.

Linx Surgery

This surgery uses a special device called a linx. It’s a ring of tiny magnetic titanium beads. When wrapped around the LES, the linx strengthens the sphincter. Because the beads are magnetised, they move together to keep the opening between esophagus and stomach closed; food can still pass through. Since it is a minimal invasive surgery, post operative effects and recovery period is less. This method is new and has shown good results.

 

COMPLICATIONS

When left untreated, GERD can lead to:

• Esophagitis
• Stricture ( narrowing of esophagus)
• Barret esophagus
• Regurgutation of acid into lungs; adult onset asthma
• Ulcerations
• Sinusitis

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